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Home My WebLink AboutWell info MINNESOTA UNIOUE WELL WELL OR B R'iING LOCATION MINNESOTA DEPARTMENT OF HEALTH AND BORING NO. co��ry Name WELL AND BORING RECORD � � �6 �5 �TR]e �n Minnesota Statutes,Chapter 103I Township Name � Township No. Range No. Sa�tion No. Fraction WELUBORING DEPTH(completed) DATE WORK COMPLETED a Ora� 1!7 23 ': 09 �, �, ,,, I08 tt 22-4-07 GPS �-� �' DRILLING METHOD �- LOCATION: Latitude degrees min "s seconds Longitude degrees mi ''tes seconds ❑Cable Tool ❑Driven ❑Dug -- j]Auger �]Rotary ❑Jetted House Number,Street Name,City,and Zip Code of Well Lo ��ion or Fire Number � 1540 Bohns Point Rd O� S�J7� DRILLING FLUID WELL HYDROFRACTURED? ❑Yes No Show exact location of well/boring in section ith"X"�� \�Sketch map of well/boring location. �(it�i=e From ft.To ft. t` ' Showing property lines, N b��' roads,6uildings,and directioa USE �Domestic I]Monitoring ❑Heating/Cooling - __j__ __y_____�____,__ � ❑Noncommunity PWS L]Environ.Bore Hole ❑Industry/Commercial �' � ❑Community PWS L�Irrigation ❑Remedial �)\ ,�Elevator [�Dewatering � w e \� CASING MATERIAL Drive Shoe? ❑Yes �f No HOLE DIAM. - --�-----�------�-- --.- - - T \ � , , , ❑Steel �]Threaded ;]Welded `, , � '�_ '/�Mile �PI � - -- -- � �,� astic CASING S � Diameter Weight Specifications �—i nniie—� �_in.to�fl. � �_IbsJR. &�9ttA �in.to_�ft. PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. � Ibs./ft. _ �.in.tolOHft. �t��w� *T n in.to _ft. Ibs./ft. in.to ft. �R,1U.� irlti OPEN HOLE Property owner's mailing address if different than well location address indicated above. SCREEN 7�Q/ n8�ta Bl�� Jte LW Taee FroDiam. ft._To ft. I�icmea lis I�At 5542b yP - -- 4 � � y� Sbt/Gauze A7 t\ Length (+�_ �.__I.�I Set between ft.and ft. FITTINGS STATIC WATER L Measured from � ft..�Below ❑Above land surface Date measur� � WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) - IQ� ft.afler 1+5 hrs.pumping �5 g.p.m. Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION - {.. �Pitless/adapter manufacturer l�}-�,��w.,_1Q�7,0.�. Model Casing Protection �12 in.above grade ❑At-grade(Ernironmental Well and Boring ONLY) GROUTING INFORMATION �� Well grouted �}Yes ❑No Grout materials ❑Neat cement �Bentonite�❑^Concrete ❑yOther From �n� To .�1 ft. -7 ❑Yds. �Bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO From JV To 7v fI�SLLICSl l�J�ds. ❑Bags MATERIAL «-! p From�To�ft�avC 1__��ds. ;�]Bags NEAREST KNOWN SOURCE OF CONTAMINATION .�. �18 t8 9(>fC 0 60 !`, ' � ., _� ,�.._ _ ;:�,s<._ ,.�_ feet direction _. .y �''type � Well disinfected upon completion? �Yes [j No �,-r...��` .3�--+�"' -%� 1�XiA1 SOl t � �O� PUMP � ❑Not installed Date installed - � ' Q Manufacturers name ��-- � Model Number HP � �a Volts �� Length of drop pipe �j�ft. Capacity g.p.m. Type: Submersible ❑LS.Turbine ❑Reciprocating ❑Jet ❑ ABAN ONED WELLS Does property have any not in use and not sealed well(s)? ❑Yes �No VARIANCE Was a variance granted trom the MDH for this well? ❑Yes �No TN# WELL CONTRACTOR CERTIFICATION t This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. The information contained in this report is true to the best of my knowledge. Use a second sheeG if needed. REMARKS,ELEVATION,SOURCE OF DATA,etc. Don Stodol.a �I1 Drilling Co., Inc. 169I Licensee Business Name � Lic.or Reg.No. �.� �'. .,�' _._.��'- �..3-4� ifted Representative Sign-�ure� Certified Rep.No. Date C �� LOCAL COPY 7 �,O 6� .J - -- Name of Driller IC 140-0020 HE-01205-10(Rev.6/O6) � M1 . � • rw� c�-yw�� c � � � .r�. 617 13th Ave So � Hopkins, Minnesota 55343 � (612) 935 - 3556 12/06/2007 Stodola Wel! Drilling 3841 North Main ' St. Bonifacius MN 55375 938-21 1 1 REPORT OF WATER ANALYSIS Lab #: BN577 Our Laboratory reports these analytical results, detevmined on a sample raken by CLIENT on 12/04/2007 from the following location: 1500 BOHNS POINT RS ORONO,MN Coliform Bacreria ABSENT Nitrates Nitrogen <1.0 mg/1 The results of these tests indicate that this well is producing water that meets rhe si-andards for F.H.A., V.A., or convent-ional loans. This report is an analysis for coliform and nitrate only and does not include analysis of Lead and other contaminanrs. (Unless as specified by client). Twin Cit�,Water Clinic, Inc. �� . Bill an Arsdale Lab Cert�cation#027-053-119 wELL Ort BORING LOCATiON MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring I„' County Name WELL AND BORING SEALING RECORD Minn'esota Unique Well No. ��Q�(�p3j1 Minnesota Statutes,Chapter 1031 or W-series No. tise�re de�n oa a�o«n> Township Name Township No. Range No. Section No. Fraction(sm->Ig) Date Sealed Date Well or Boring Constructed Jrcmo I17 2 fl9 3 5'. ,. ,. .- GPS �a� degrees minutes seconds � LOCATION: Depth Before Sealing �� ft. Original Depth (t. Longitude degrees minutes seconds p FER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location ngle Aquifer ❑Multiaquifer WELUBORING �Aeasured ❑Estimated [�Vater Supply Well ❑Monit.Well i Show exad location of well or boring Sketch map of well or boring /�t in section grid wiTh'X' '�y location,showing property ❑Env.Bore Hole ❑Other �ft. [�elow ❑above land surface N �� lines,roads,and buildings� CASING TYPE(S) � -T- -T- -�-- -,-- �teel ❑Plastic ❑Tile ❑Other i W "f- 'Y' -1" "l" E �� p WELLHEADCOMPLETION � Outside: ❑Well House Inside: ❑Basement Offset --�- -i-- -f- -f- �� Pitless Adapter/Unit ❑Well Pit --�- -i-- -�-- -�-- � � � ; ❑Well Pit ❑Buried g \\ �—"^'�—�' �� ❑Buried PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) � Diameter � Depth � Set in oversize hole? Annular space initially grouted? Properry owner's mailing ess it different than well location address indicated above �� "� in.ffOm�_ t0��ft. ❑Yes �No ❑Yes ❑No ❑Unknown �� 24(�l4 Veit Piace R��r$� t� 55374 i11.ffOm t0 ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown P � � in.from t0 ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown W LL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE r /�+�y � Well owner's mailing address it different ihan property owners address indicated above Screen from�t0�ft. Open Hole from t0 ft. OBSTRUCTIONS �Rods/Drop Pipe ❑Check Valve(s) ❑ Debris ❑ Fill ❑ No Obstruction Type of Obstructions(Describe) .1 ua/f� �,£i�� U r�� GEOLOGICAL MA7ERIAL COLOR HARDNESS OR FROM 70 Obstructions removed? es ❑ No Describe FORMATION If not known,indicate esromated fortnation log from nearby well or borinq PUMP /� t�C�.f� � 77 TYPe .1 c.s.r. /` (.J�1(� �emoved ❑ Not Present ❑Other METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: ❑�lo Annular Space Exists ❑ Annular space grou[ed with tremie pipe ❑ Casing Perforation/Removal in.from to ft. ❑ Perforated ❑ Removed in.from to ft. ❑ Perforated ❑ Removed Type of perforator ❑ Other GROUTING MATERIAL(S) (One bag of cement=941bs.,one bag of bentonite=SO lbs.) Grouting Material_�L�� r/��ofFi—s.C_to�ft. yards � bags from to ft. yards bags from to ft. yards bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed and unused well or boring on property? ❑ Yes No How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The intormation contained in this report is true to the best of my knowledge. Tait#t�todc�Is �11 Dtiilis�; Co.. Inc. 27172 Contractor Business Name License or Registration No. '`�,�� r� ;�. r 11��T15 Authorized Representative Signature Date LOCAL COPY H �i�3��8 �j'�"1 `St�CI1�C ��'� ��. Name of Person Sealing Well or Boring